Accuracy of Preoperative MDCT in Patients With Penetrating Abdominal and Pelvic Trauma

Abstract

Purpose: This study aims to evaluate the overall diagnostic accuracy of preoperative multidetector computed tomography (MDCT) in penetrating abdominal and pelvic injuries (PAPI). Method and Materials: We used our hospitals’ trauma registry to retrospectively identify patients with PAPI from January 1, 2006, to December 31, 2016. Only patients who had a 64-MDCT scan at presentation and subsequently underwent laparotomy or laparoscopy were included in our study cohort. Each finding noted on MDCT was rated using a 5-point scale to indicate certainty of injury, with a score of 0 being definitive. Using surgical findings as the gold standard, the accuracy of radiology reports was analyzed in 2 ways. A κ statistic was calculated to evaluate each pair of values for absolute agreement, and ratings for all organ systems were analyzed using a repeated measures analysis of variance (ANOVA) to determine whether radiology and surgical findings were similar enough to be clinically meaningful. Qualitative review of the radiology and surgical reports focused on the gastrointestinal (GI) tract was conducted. Results: Our cohort consisted of 38 males and 4 females with a median age of 29 years and a median injury severity score of 15.6. For this study, 12 different organ groups were categorized and analyzed. Of those organ groups, absolute agreement between MDCT and surgical findings was found only for liver and spleen (κ values ranging from 0.2 to 0.5). Additionally, the ANOVA revealed an interaction between finding type and organ system ( F 1, 33 = 7.4, P < .001). The most clinically significant discrepancies between MDCT and surgical findings were for gallbladder, bowel, mesenteric, and diaphragmatic injuries. Qualitative review of the GI tract revealed that radiologists can detect significant findings such as presence of injury, however, localization and extent of injury pose a challenge. Conclusion: The detection of clinically significant injuries to solid organs in trauma patients with PAPI on 64-MDCT is adequate. However, detection of injury to the remaining organ groups on MDCT, especially bowel, mesentery, and diaphragm, remains a challenge.

Accuracy of CT Scan for Detecting Hollow Viscus Injury in Penetrating Abdominal Trauma

“…In keeping with the international and local literature, the majority of patients who present to our trauma unit are males between the ages of 25 and 36 yrs [1–3, 13, 15]. As demonstrated by the results of this study, stab wounds predominate in South Africa.…”

“…Although triple-contrast CT has been proven to be accurate in identifying HVI in penetrating trauma, IV contrast-only CT scans are routinely performed by the CMJAH Trauma Unit [ 12 , 13 , 20 ]. A major disadvantage of enteric contrast is the time delay necessary for enteric opacification, which is the rationale for using single-contrast CT, especially in our resource-constrained environment.…”

“…We included intra-abdominal free air and fluid, which are non-specific, indirect features of an HVI, as they could also be due to peritoneal violation. The presence of only these findings on CT can result in high false-positive rates [ 13 ]. Another contributing factor to the low specificity of our study is that the majority of patients in this study had negative CT scans and were observed successfully.…”

“…Triple-contrast CT (intravenous (IV), oral, and rectal contrast) has been proven to be accurate in identifying hollow viscus injuries (HVI), defined as injuries sustained anywhere along the gastrointestinal tract [ 12 , 13 ]. However, it has been shown that there is no diagnostic benefit in the addition of enteric contrast for detecting HVI compared to an IV contrast-only CT.…”

“…In recent studies, single-contrast CT has a sensitivity of 75–88% and specificity of 48–100%. However, these studies were limited by small numbers and study design [ 4 , 13 , 15 ].…”